stick a fork in me, I'm done

ALL DONE ALL DONE ALL DONE!!!!!!!!!!!!!!!!!!!!!!!!!

ALL. DONE. WITH. CHEMO. and I'm gonna go ahead and say it FOREVER!

Yep, I said forever.  Welcome to my mood swing, jump onto my roller coaster, it's a fun ride.  Today I am saying ALL DONE FOREVER.

Yesterday's chemo was fairly uneventful although very looooooooooooooooooooooooong.  We had a long meeting with Dr Kurup, talking about the future and our next steps.  She wants to see me my last week of radiation as a check up and to run my numbers to make sure I am healing.  That is when we will talk about starting Tamoxifen - the estrogen blocking drug that I will be on for 5 years.  This drug does not stop my body from producing estrogen (like the hormone blocking therapy that Dr Chui recommended).  Tamoxifen blocks my body's estrogen from bonding with breast cancer cells, making it so that estrogen is not the fertilizer that my cancer loves.  Other than that it was a pretty routine appointment, with the exception that we were all giving each other emotional high fives for making it all the way through and getting to our last chemo session.


Now another thing I was worried about for yesterday but didn't want to talk about (because sometimes don't you feel like if you say it, it will happen?) - I was worried my numbers wouldn't be good.  I had tell tale signs for the entire 2 weeks after last chemo that my platelet count was low.  No dramatic bruising (just some light ones) but a lot of bleeding out of the nose.  Nothing gushing....just more blood than normal and it didn't go away until a couple days before chemo this round.  When I mentioned this to Dr Kurup she frowned and said, let's get the results of your blood work stat.  It wasn't in the system yet, so she walked over to the lab.  I was nervous the entire time (especially since the frown!).  When she came back in she had total poker face and then said "149".  WHAT? My platelet count is 149!!!  That is fantastic!  I whooped! It has to be over 100 to continue!  Another emotional high five.  Never been so stoked to hear that I could get chemo :) 
And the best thing about yesterday - we had Karen!!!!!!!!!!!  I cheered when she came into the exam room.  I told her I missed her and was so glad that she was here for my last session.  She said she made sure that she got me today when she saw me on the calendar (oh, and bonus news, she has been on vacation for the past 2 1/2 weeks so it's not that she didn't pick me last time! My ego was intact).  When Karen was looking for a good vein she said she was glad that this was my last session.....I didn't have many more pokes left in my left arm.  Now, I can't remember if I've talked about this before (chemo brain and all) so if I have just skip to the next paragraph.  The reason that they can only use my left arm is that I had some lymph nodes removed from my right arm.  So for the rest of my life I cannot get my blood pressure taken on that arm, have an IV inserted, or in general have any kind of trauma or pressure on that arm.  These are all precautionary measures to make sure that I do not get lymphodema.  Lymphodema is not a super fun thing where fluid would drain to the bottom of my arm (because of the removal of some lymph nodes in the armpit) and it would never drain out resulting in a swollen arm.  This is permanent.  Obviously, I do not want lymphodema so will be doing everything possible to make sure I don't get it.

Karen looked over my notes from last time, obviously did NOT like that I vomited and said she would take care of me.  When I was all settled in my chair in the infusion room, before we started any of the drips, she leaned over and said - would you like some Ativan today?  YES PLEASE.  She said that it wasn't on Dr Kurup's notes for me today, but she thought I needed it since I threw up last time.  I mean, don't we love Karen?  We slowed the drip down BIG TIME to make sure I didn't have any reactions (like vomiting).  Like super super super slow.  My appointment yesterday started at 10:40am and we didn't get out of there until almost 5pm.  I took my usual 2 hour snoozer.  Again, it was that super light sleep where I could hear everything around me.  I woke up around 2pm, I could hear Heather and Bob whispering.  Heather had arrived for our last day chemo party and brought some lunch for us.  One thing I didn't even think about that Heather mentioned - she said, wow, aren't you glad you made it this whole time without getting a port!!!!!!!  Hell yeah I am! Two less surgeries (one to put it in, one to take it out) and no big scar on my chest! Another high five.

Chemo ended FINALLY and I hugged Karen and told her how wonderful she was.  Bob had joked that we never wanted to see her again, but Karen and I both agreed we'd love to see each other again....just not in the infusion room :)

Bob and I headed home, pooped and exhausted from the long day.....but both so stoked.  LAST CHEMO EVER.

This morning I had an appointment to meet my radiation oncologist.  I liked her immediately.  She came recommended from Dr Kurup's office.  She is just downstairs (in the basement) in St Vincent's, where I used to get my chemo infusions (love to say used to).  Her name is Dr. Jeanie Louie, and she is warm, friendly, super smart...she reminded me a lot of my rock star surgeon Dr. Langer.  She said she had talked to Dr. Langer this morning about my case (she says hello) and just to get more details than what the medical notes said. 

For me she is recommending 7 1/2 weeks of radiation (about 2 more weeks more than "standard").  This is called "boost dose" radation therapy.  It would be about 37 doses (or fractions) of radiation instead of 28.  Why am I getting more than the standard?  For one, I am 34 and she is not just concerned about 10 years out for me (which is the number most doctors talk about), she wants me to live another 50 years with no recurrence.  I didn't even set her up for this one, she voluntarily said this.  I could have hugged her.  She also said because during my surgery in one area they were only able to get 1cm of clean margin when taking out the cancer. 2cms of clean margins is the industry standard.  The reason we could only get 1cm in one spot is that there wasn't anything more to take - it was right at the edge of my skin.  My surgeon was not concerned about this 1cm clean margin just for this reason (since there was nothing more to take out) but Dr. Louie just wants to be extra cautious.  I asked her if there were any addition side effects for going longer (getting the extra boost) and she said only firmer tissue around the scar.  That's it?  Longer survival and less recurrence and the only side effect is firmer tissue around the scar?  Bring it.  I told her we weren't in any rush anyway.  Although a little piece of me did an internal UGH when I heard 7 weeks instead of 5.  This puts us ending around the 1st or 2nd week of November (depending on my start date). 

There are a couple of other therapy routines out there that is not recommending for me.  They are new(er) and only have data that is 10 or 5 years out and she only wants to give me something that has the numbers to back it with a low recurrence rate 20+ years out.  Those other 2 therapies are called the Canadian Treatment (higher doses 2x a day, so less total days under the machine) and Balloon therapy where they actually insert a balloon or catheter inside your breast and give high doses of radiation.  This is also called accelerated partial breast irradiation and only takes about 5-7 days.  Sounds great right?! Well, they only have data on it for 5 years and since I don't want to make another visit in 5 years, I'm all set on that one.

In terms of start date, they want me to come back in 2 weeks for our "planning session".  This is where they make a mold of my body so that when I lay under the radiation machine I cannot move and the radiation will go to the exact TARGETED area that they want it to go.  This is important because we are trying to avoid my major organs....like lungs and heart so that I do not have long term damage there.  I will also have a CT scan at this appointment in order to determine exact location of the radiation beam.

1 week after that appointment we do a 2nd simulation and if all looks good, then all systems go and we start radiation that day. 

Side effects from radiation are mostly localized to the radiation site - sunburn like sensation, general tenderness, swollen boob.  They recommend aloe 2x/day to help this, and a mixture of 1 part cornstarch and 1 part baking soda for my "folds" (under the boob, in the armpit) so that there is less friction. 

The other side effect that I had been (UGH) dreading is the fatigue.  We all know my fatigue level is at an all time high.  I don't even remember what it feels like to have energy anymore.  But when I asked about this (is the fatigue as bad as chemo) she said that in most patients that they talked to had rated chemo fatigue at a 10 (yeah, tell me about it) and then radiation fatigue at a 2.  A two?!?!?! I can do a 2!  Now, am I banking on this?  No.  Most people don't feel like they got into a car wreck with Taxol.  Most people don't vomit during chemo.  So I'm not gonna believe it until I see it......but I am super stoked that hopefully I will be most people!

The long terms side effects have very low percentage rates attached to them.  Less than 2% of the patients get pneumonitis (pneumonia like symptoms in your lungs, another reason to avoid that area).  This is treatable with antibiotics.  Less than 1% of patients get cancer from the actual radiation.  

Now in case you are wondering WHY oh WHY isn't this just all over yet, why are you doing radiation?  It is of course, a numbers game and statistics.  30+ years ago they did a study where they took 1,600 women with breast cancer.  1/3 of these women just had a mastectomy, 1/3 just had a lumpectomy, and 1/3 had lumpectomy with radiation.  The third that just had mastectomy had a 10% recurrence rate.  The 1/3 that just had lumpectomy had a 40% recurrence rate (holy shit).  The 1/3 that had lumpectomy and radiation had the same rate as the ladies with the mastectomy -  10%.  This was a total game changer for cancer (obviously) since 30+ years ago if you had breast cancer, they would almost always recommend going the distance and removing one if not both breasts.

So, now I start my 3 week "rest" where I heal and get my numbers up and just in general give my body a rest.  I'm ready for it, but I'm also ready to start radiation STAT and kinda wish we could get it over with. 

Today I am feeling good...I have all sorts of what I call "fake energy" from the steroids.  I know that I will start to wind down soon...tomorrow and Sunday will be no picnic.  But guess what?  This is the last time I will have to feel like this ever so BRING. IT. ON.